Violence against Women: An Urgent Public Health Priority
Garcia-Moreno, Claudia, Watts, Charlotte, Bulletin of the World Health Organization
Violence against women has been described as "perhaps the most shameful human rights violation, and the most pervasive." (1) Addressing violence against women is central to the achievement of Millennium Development Goal (MDG) 3 on women's empowerment and gender equality, as well as MDGs 4, 5 and 6. (2) It is also a peace and security issue. In spite of this recognition, investment in prevention and in services for survivors remains woefully inadequate.
Research on violence against women--especially male partner violence--has increased. Since 2005, when the first results of the World Health Organization (WHO) Multi-Country Study on Women's Health and Domestic Violence (3) were launched, the number of intimate partner violence prevalence studies increased fourfold, from 80 to more than 300, in 2008. We now have population-based prevalence data on intimate partner violence from more than 90 countries, although there are still some regions--such as the Middle East and west Africa--where there is relatively limited data. Similarly, there is also a growing body of evidence about the range of negative health and development consequences of this violence.
Women suffer violent deaths either directly--through homicide--or indirectly, through suicide, maternal causes and AIDS. Violence is also an important cause of morbidity from multiple mental, physical, sexual and reproductive health outcomes, and it is also linked with known risk factors for poor health, such as alcohol and drug use, smoking and unsafe sex. (4,5) Violence during pregnancy has also been associated with an increased risk of miscarriage, premature delivery and low birth weights. (6,7)
When the cumulative impacts on mortality and morbidity are assessed, the health burden is often higher than for other, more commonly accepted, public health priorities. In Mexico City, for example, rape and intimate partner violence against women was estimated to be the third most important cause of morbidity and mortality, accounting for 5.6% of all disability-adjusted life years lost. (8) In Victoria, Australia, partner violence accounted for 7.9% of the overall disease burden among women of reproductive age and was a larger risk to health than factors such as raised blood pressure, tobacco use and increased body weight. (9)
In addition to the human costs, research also shows that violence has huge economic costs, including the direct costs to health, legal, police and other services. In 2002, Health Canada estimated that the direct medical costs of all forms of violence against women was 1.1 billion Canadian dollars. (10) In low-resource settings, relatively few women may seek help from formal services, but because of the high prevalence of violence, the overall costs are substantial. In Uganda, for example, the cost of domestic violence was estimated at 2.5 million United States dollars in 2007. (11)
The broader social costs are profound but difficult to quantify. (12) Violence against women is likely to constrain poverty reduction efforts by reducing women's participation in productive employment. Violence also undermines efforts to improve women's access to education, with violence and the fear of violence contributing to lower school enrolment for girls. …